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PSA & re-occurrence flag

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User
Posted 26 Apr 2017 at 18:14
If Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland, does PSA only increase as a result of Cancer that occurs within the Prostate gland, or can Cancer outside of Prostate gland also cause a PSA increase ?

As all Prostate Cancer originates within the Prostate gland, then PSA is a good indicator that further investigation is required, however if diagnosed as locally advanced, and Hormone therapy + Radiotherapy + Hormone therapy treatment regime appears to have done it's job, it would be common practice to have 3 or 6 monthly blood test with a new PSA increase being the potential indicator of some re-occurrence, but what if Prostate gland itself was still all clear, and because of some previous microscopic spread that hadn't been fully eradicated through RT, the re-occurrence had actually occurred somewhere outside the Prostate gland (in adjacent Pelvic area) would such Cancer that had resurfaced outside of the Prostate gland show up through an increased PSA level ?

Hope I have managed to explain this hypothetical scenario correctly.

Summary,

How would re-occurrence outside the Prostate gland be detected ? would it actually show as an increased PSA ? or is PSA only produced by cancerous cells of the prostate gland ?

Any comments appreciated.

Graham.

User
Posted 27 Apr 2017 at 00:35

In the vast majority of cases cancer cells whether in the Prostate or elsewhere as they become more prevalent will result in a rising PSA. However, in a very small number of cases and depending on the type of PCa, there can be low or even undetectable PSA but still cancer, so "don't live and die by PSA"! This is illustrated in a lecture by Dr Kwon which I have posted in the past but which I strongly recommend anybody who has not seen it views. It is quite long and you need to get past the opening credits and introductory remarks. to get to the really interesting part. It helps one realize how unpredictable PCa can be. - https://www.youtube.com/watch?v=NkqizmvqJPo

Barry
User
Posted 27 Apr 2017 at 09:56
Once undergoing hormone treatment it is important to have the levels of your testosterone checked in case the hormone treatment is no longer effective at least that's what my husband's oncologist recommends . If the testosterone level rises then the cancer has become castrate resistant and you may need a different tratment
User
Posted 01 May 2017 at 22:33

Sounds like your surgeon is a bit behind the times or simplistic Peter - there is no such thing as zero in PSA terms (even women can have a PSA of around 0.02) and the ultrasensitive test has been discredited rather as unreliable and too susceptible to machine noise. The Wife is quite correct that anything less than 0.1 is considered undetectable and NICE defines recurrence as a PSA of 0.2 or above, or 3 successive rises above 0.1

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 02 May 2017 at 00:07

The science says the same blood sample can fluctuate by as much as 0.05 in the same machine. We have tried it - having two phials of blood tested at the same time gave different results. Dad had the same sample tested at two labs and the difference was significant.

Our hospital (a leading oncology centre of excellence) has now stopped all ultra-sensitive PSA testing.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 26 Apr 2017 at 22:30

Good question Graham, something I've wondered myself.
But sorry, I can't Give any answers but I'm sure someone can.

Cheers

Paul

User
Posted 26 Apr 2017 at 22:42

Prostate cancer cells anywhere in the body will produce PSA. For men who have had their prostate removed PSA should be undetectable or less than 0.1. Testing is done post operation to check that all cancer was removed during the operation. A PSA above 0.1 indicates that there are some prostate cancer cells left somewhere in the body either in the prostate bed, in the surrounding lymph nodes, etc.

User
Posted 27 Apr 2017 at 00:35

In the vast majority of cases cancer cells whether in the Prostate or elsewhere as they become more prevalent will result in a rising PSA. However, in a very small number of cases and depending on the type of PCa, there can be low or even undetectable PSA but still cancer, so "don't live and die by PSA"! This is illustrated in a lecture by Dr Kwon which I have posted in the past but which I strongly recommend anybody who has not seen it views. It is quite long and you need to get past the opening credits and introductory remarks. to get to the really interesting part. It helps one realize how unpredictable PCa can be. - https://www.youtube.com/watch?v=NkqizmvqJPo

Barry
User
Posted 27 Apr 2017 at 07:26
Thanks for the link Barry.

Very interesting and informative presentation, and slightly frightening.

Nothing to actually suggest it's a real problem for me, but definitely on my list of things to discuss at my next review meeting with my Oncologist, as fear of re-occurrence is a very real concern for me.

Thanks,

Graham.

User
Posted 27 Apr 2017 at 09:56
Once undergoing hormone treatment it is important to have the levels of your testosterone checked in case the hormone treatment is no longer effective at least that's what my husband's oncologist recommends . If the testosterone level rises then the cancer has become castrate resistant and you may need a different tratment
User
Posted 27 Apr 2017 at 14:49

Hi Graham

Reading your post, I assume you realise PSA is not a cancer test.  It has taken me years to understand even the basics.  

Have a look at Chris J posts/profile, if you haven't  to see some of the challenges.

Some info on here : 

https://cancerimagingjournal.biomedcentral.com/articles/10.1186/s40644-016-0072-6

#Barry  - Many thanks for vid. link  - just viewed it.

I agree Graham, quite frightening the more you know,  I didn't realise zero PSA could 'mask' active cancers (again from video you can't gain % incidence etc or is it very rare).

To answer your query : Ask your consultant any latest studies / research / data.  Unless you know the problem - ie the exact location or locations of any re-occurrence, that DR in video is correct. Current medical practice is targeting generically (blind?) in my opinion also. 

You yourself won't know success/remission for probably 2 to 3 years (perhaps clarify that statement with him ?).  You raise an interesting point, which leads on,   if one has sufficient funds should one seek out finer scans wherever in the world ?

or is it que sera sera eh ?

I have no prostate so logical any re-occurrence must be elsewhere, re . RT you still have active prostate material.    The video link from Barry was very thought provoking as not seen that one, my father developed a large lump on his sternum before he died (see my profile).         

 

Gordon

 

 

User
Posted 01 May 2017 at 22:10

Hi Graham,

I think your question is do cancer cells outside the prostate create psa.  

As 'The Wife' says in her reply, yes they do.  The Wife also uses the figure of less than 0.1 as undetectable.  However my surgeon said anything above Zero has some concern.   My local hospital has a machine that says my PSA is <0.06 which is the limit of its measurement.   The surgeon asked me to use his hospital in future which can measure to 0.005.  I've just been and am now waiting for the result.

Regards

Peter

User
Posted 01 May 2017 at 22:33

Sounds like your surgeon is a bit behind the times or simplistic Peter - there is no such thing as zero in PSA terms (even women can have a PSA of around 0.02) and the ultrasensitive test has been discredited rather as unreliable and too susceptible to machine noise. The Wife is quite correct that anything less than 0.1 is considered undetectable and NICE defines recurrence as a PSA of 0.2 or above, or 3 successive rises above 0.1

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 01 May 2017 at 23:15

HI Lyn,

Thanks for the comment, I've enjoyed reading your posts.  The clinic was run by a locum surgeon who didn't do my operation, and after he said about zero, he backtracked a bit by saying I could use my local hospital if I wanted. 

I decided to go to the regional hospital because it seemed to me that a trend from say 0.03 has more meaning than one from 0.07.  Although it could give me more to worry about earlier.  I noted from your own profile that the psa can fluctuate 0.01 between tests.

Although NICE sets the standards in the UK I often wonder if their definition is based on cost or best treatment.  I had a skin cancer that NICE said was not to be treated as urgent, the result being that it grew to 1 inch across and needed a big graft, I presented it to my GP at less than a quarter of an inch across.

Regards
Peter

User
Posted 02 May 2017 at 00:07

The science says the same blood sample can fluctuate by as much as 0.05 in the same machine. We have tried it - having two phials of blood tested at the same time gave different results. Dad had the same sample tested at two labs and the difference was significant.

Our hospital (a leading oncology centre of excellence) has now stopped all ultra-sensitive PSA testing.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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